Provider Demographics
NPI:1639266869
Name:LIVONIA MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:LIVONIA MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACMARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-427-3500
Mailing Address - Street 1:9216 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4036
Mailing Address - Country:US
Mailing Address - Phone:734-427-3500
Mailing Address - Fax:734-427-9234
Practice Address - Street 1:9216 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4036
Practice Address - Country:US
Practice Address - Phone:734-427-3500
Practice Address - Fax:734-427-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty